Klaudia Vyskocilova1, Lenka Spinarova1, Jindrich Spinar2, Tereza Mikusova1, Jiri Vitovec1, Josef Malek3, Filip Malek4, Ales Linhart5, Marian Fedorco6, Petr Widimsky7, Cestmir Cihalik8, Jiri Parenica2, Simona Littnerova9, Jiri Jarkovsky9. 1. 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital in Brno, International Clinical Research Center and Faculty of Medicine, Masaryk University, Brno, Czech Republic. 2. 1st Department of Internal Medicine - Cardiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno. 3. Internal Department, Hospital Havlickuv Brod, Havlickuv Brod. 4. Department of Cardiology, Na Homolce Hospital, Prague. 5. 2nd Department of Internal Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague. 6. 1st Department of Internal Medicine - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc. 7. Cardiocenter, University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine, Charles University in Prague. 8. Department of Internal Medicine, T. Bata Regional Hospital, Zlin. 9. Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Sciences, Masaryk University, Brno.
Abstract
AIMS: Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). METHODS: The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. RESULTS: In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. CONCLUSIONS: Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.
AIMS: Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). METHODS: The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. RESULTS: In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. CONCLUSIONS: Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.
Authors: D M Longo; G T Generaux; B A Howell; S Q Siler; D J Antoine; D Button; A Caggiano; A Eisen; J Iaci; R Stanulis; T Parry; M Mosedale; P B Watkins Journal: Clin Pharmacol Ther Date: 2017-05-27 Impact factor: 6.875